Team:IISER Mohali/Communication

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Communication

Communication

Engagement with Professionals


First leads: Dr. Mahak Sharma

Background: Thorough literature reviews on the topic led us to conclude that expression of the wild-type p53 suppresses tumour growth[8]-[13]. We came up with a concept to introduce a wild-type p53 gene in the cancer cells to tackle uncontrolled divisions. However, we discussed two significant hurdles: how do we specifically target cancer cells in an infected human body, and how do we cause tumour regression?

Feedback: Seeing this as a positive lead, we went on to discuss the idea with Dr. Mahak Sharma, Asst. Prof. at IISER Mohali, who is an expert on Cancer Biology. Dr. Mahak gently nudged us to focus on specific cancer types due to behavioural habits particular to the Indian population.

Implementation: This made us realign our focus from cancer in general to oral cancer in particular. As we read more and more about oral cancer, we realized the magnitude of the problem, especially in India, as it makes up almost one-third of the total cancer cases around the globe[14]. Additionally, the prevalent use of cigarettes, smokeless tobacco, liquid betel, betel nut chewing, pan, alcohol etc., severely increases the risk of developing oral cancer[15].

Expert’s Opinions: Dr. Sushmita Ghoshal

Background: We wanted to investigate the ground reality of the problem in the vicinity of our institute, so we chose to go to the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, which is the “leading tertiary care hospital” of the northern region of India. It caters to patients from the states of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Uttarakhand.

Feedback: We reached out to Prof. Sushmita Ghoshal, the head of the radiotherapy and oncology department in PGIMER. She confirmed the severity of the problem, giving an example of the huge number of cases their department gets every day. Almost all cases received are oral squamous cell carcinoma (OSCC) that affect the squamous cells in the epidermal lining[16]. She also explained that OSCC itself is positively preventable and even treatable, given that it is detected early on[17]. But late detection also comes with a lot of painful and invasive procedures like biopsy[18].

Implementation: From then on, we began searching for various biomarkers for OSCC in different body fluids and specifically wanted to detect them via non-invasive techniques. Previous studies that we found were based on mRNA biomarkers[19]-[22]; however, the mRNA molecules are quickly degraded in the body and are hard to keep track of[23]. After more days of literature survey, we finally settled on proteases found in the saliva. We chose proteases based on the fact that they will be able to cleave a substrate according to their enzymatic activity.
We found a research article in the International Journal of Oral Science, Nature, which screened the salivary spectrum of OSCC patients in China[24]. Four proteases, namely MMP1, Cathepsin V, Kallikrein 5 and ADAM9, gave optimal sensitivity and specificity under the curve for appropriate diagnosis of OSCC.

Feedback: We reached out to Prof. Sushmita Ghoshal, the head of the radiotherapy and oncology department in PGIMER. She confirmed the severity of the problem, giving an example of the huge number of cases their department gets every day. Almost all cases received are oral squamous cell carcinoma (OSCC) that affect the squamous cells in the epidermal lining[16]. She also explained that OSCC itself is positively preventable and even treatable, given that it is detected early on[17]. But late detection also comes with a lot of painful and invasive procedures like biopsy[18].

Implementation: From then on, we began searching for various biomarkers for OSCC in different body fluids and specifically wanted to detect them via non-invasive techniques. Previous studies that we found were based on mRNA biomarkers[19]-[22]; however, the mRNA molecules are quickly degraded in the body and are hard to keep track of[23]. After more days of literature survey, we finally settled on proteases found in the saliva. We chose proteases based on the fact that they will be able to cleave a substrate according to their enzymatic activity.
We found a research article in the International Journal of Oral Science, Nature, which screened the salivary spectrum of OSCC patients in China[24]. Four proteases, namely MMP1, Cathepsin V, Kallikrein 5 and ADAM9, gave optimal sensitivity and specificity under the curve for appropriate diagnosis of OSCC.

Inputs from People on ground

Dr. Arnab Pal, PGIMER Chandigarh

Choosing our proteases

Background: To generate ideas on the current facilities available for testing and points on which it can be improved upon, we reached out to Dr. Arnab Pal, an oncologist in PGIMER, who was involved in quantifying salivary proteins in OSCC patients using LC-MS.

Feedback: Detailed discussions with him on the existing literature[25]-[31] and his own experience, provided us with a host of data on proteases.

Implementation: Through analysis of this data, it led us to extrapolate that testing the concentration levels of a combination of MMP 9, KLK 1 and KLK 11 will be an excellent litmus test for checking the probability of OSCC in a patient.


Dr. Shefali Bansal, AIIMS Delhi

Background: We also reached out to Dr Shefali Bansal, MBBS from PGIMER, Rohtak and is now pursuing her MS from AIIMS Delhi.

Feedback: She confirmed Dr. Pal’s words that most patients affected by OSCC come for their first check-up when it is already in TNM (Tumor, nodes, and metastasis) stage 3. She shared her belief that OSCC is widely found in India because of the prevalent use of chewing tobacco and cigarettes and a lack of awareness campaigns; this does not make people consider the severe health implications of such products. Dr Bansal further added that the average cost of medications in stages 1 and 2 is around 50k INR, but it sky-rockets for the 3rd stage, reaching more than 2 lakh INR, a four-fold increase.

Implementation: Hence, it would be highly advantageous if patients were mindful of the symptoms that manifest the disease in the early stages and prevent the risk of developing a metastatic tumour. We therefore started planning an awareness talk by an oral cancer specialist for school students (mainly highschool) and their teachers https://youtu.be/6yHO3wpGbWw. The target audience were mainly students and teachers because we wanted to alarm impressionable minds of students, who are mostly not yet exposed to the practice of using addictive carcinogens, explain their severe health concerns, and make them aware about oral cancers. The teachers also need to be aware so that they do not chew Pan/Gutka and such things in front of their students, and also make their students aware about the problems from these and prevent them from building such habits. Furthermore, these people can also spread awareness of oral cancer among their elder family members, which is otherwise quite difficult.

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